Healthy Weston

Since our last update in October, doctors and local health leaders have continued their work considering what services the population in Weston-super-Mare, Worle and the surrounding areas needs in the future and how they can best be delivered. Healthy Weston: why our local health services need to change, has been published which sets out the four key issues that need to be addressed:

Our population is growing, getting older, living with more long-term conditions, and there are significant inequalities in health amongst our local communities – people have changing health needs we need to meet

There is variation in the way GP, primary and community care teams currently provide care across the area, with some patients finding it more difficult than others to access the right care for example

Some of our hospital-based services at Weston are not able to consistently meet national clinical quality standards because of low volumes of particular cases and specialist staffing shortages

There is a growing financial gap between rising costs and available funding. We must live within our means, get best value and make sure we use our available financial resources most effectively to meet the needs of the whole population.

As we have already said, we must make some changes across the local health and care system in order to tackle these issues.

Progress being made

We are continuing to make progress against the three areas of change identified through conversations with staff, patients and local people:

Changes we can put in place immediately and are getting on with; such as better support for people in care homes, improving home visiting by GPs, and developing a consistent approach to frailty assessments in the community. A recent example is the £400,000 funding received by eleven GP practices in Weston, Worle, Banwell and Winscombe for the Intensive Support Scheme (ISS) project. This will be used to improve and develop services for patients and improve patient care by improving patient access, providing greater continuity of care and supporting recruitment and retention of GPs and nurses

Changes we can implement imminently but require further work; for example, developing a business case to establish a mental health crisis and recovery centre in the centre of Weston, and better integrating children’s services across different provider organisations

Changes that would enable us to ensure we have a strong and focused hospital at Weston, with services that can consistently deliver to the highest clinical quality standards and are affordable for the long-term within our available funding; for example, developing better multi-agency working and identifying new clinical models and ways to deliver services sustainably.

Designing strong and focused services at Weston General Hospital

As we have previously set out, we are continuing to focus on how we can design strong and sustainable services at Weston hospital, to make sure it can continue to deliver high quality services that best meet local people’s needs into the future. This includes identifying the services that Weston General Hospital is best placed to provide, and which services may be more effectively provided to local people by one of our neighbouring hospitals or in the community.

Similarly, there may be services currently provided in other places which are better delivered and consolidated in Weston hospital. The issues we face here are common to many communities with smaller hospitals across the country and our ambition is that we make Weston Hospital an exemplar of how services can be designed and delivered sustainably by smaller hospitals in the future.

In our October update, we outlined that clinicians had identified six clinically possible models for further detailed analysis and work because they were distinctive and different enough to be explored, tested, analysed and compared further as part of a rigorous process to identify the best potential way of delivering services. It is important to emphasise none of these models have been selected for Weston.

Since then, clinicians have applied each model specifically to the needs of people in Weston, looking at current services delivered across Weston-super-Mare, Worle and the surrounding area, the workforce needs and costs of each model and so on.

Work has been ongoing too to describe in detail the different elements of each model, how clinical services would work with each other, what the requirements would be to deliver these services, and to identify which different types of patients with different conditions, or severity of condition, would be treated differently under each model compared to now. Across all the models the vast majority of patients who currently use Weston General Hospital would continue to do so.

In late November we tested our work with the South West Clinical Senate – a group of senior doctors and other health professionals from across the south west region set up to give independent clinical scrutiny, advice and guidance to NHS bodies. They were supportive of our work to date and gave valuable feedback to inform the next stage of our design work.

On 3rd December, we explained our work and gathered feedback and views from stakeholders and members of the public at several events held in Weston. You can read about the detail of the work in the event presentation slides.

Ongoing engagement

We are continuing to talk with staff, stakeholders, patients and local communities and listen to their views on our work to date to ensure that concerns, feedback, opportunities and benefits from a range of different perspectives are captured and inform the work as it progresses.

We are running a series of roadshows out in the community, have provided information online and through leaflets and posters in GP surgeries, hospital waiting rooms and community spaces, and launched an online survey to hear what people think.

Next steps

Clinicians are continuing their work to determine the best, most viable, workable options that meet local needs and further detailed analysis is being carried out to enable us to identify the preferred option(s) for public consultation early next year. We will be meeting with the local authority scrutiny committee and our national regulator NHS England before finalising a detailed business case which CCG Governing Body members will use to decide on options for consultation early next year.

No final decisions have been made on the future of services and won’t be until after a formal public consultation next year.

We will continue to give regular updates on this important work and the progress we are making.

On 3 December, local doctors and health leaders provided a further update on the work they are progressing to consider what services the population in Weston-super-Mare, Worle and the surrounding areas needs in the future and how they can best be delivered.

They gathered feedback and views from stakeholders and members of the public and are continuing to talk with staff, stakeholders, patients and local communities to listen to their views on the work to date to ensure that concerns, feedback, opportunities and benefits from a range of different perspectives are captured and inform the work as it progresses.

Bristol, North Somerset and South Gloucestershire Clinical Commissioning Group has published Healthy Weston: why our local health services need to change. The document sets out why we need to change how we organise and provide healthcare differently in the future across primary and community services as well as at Weston General Hospital to best meet the needs of local people.

It sets out four key challenges that we are facing:

Our changing health needs: Our population is growing, getting older, living with more long-term conditions and there are significant inequalities in health

Variations in care and access in primary and community care: There are differences in the quality and way care is currently provided; some patients also find accessing care more difficult than others

Meeting national clinical quality standards: Some services at Weston General Hospital don’t have sufficient volumes of certain cases and there is a shortage of doctors, nurses and other staff

Getting value for money: We must live within our financial means and make sure we use our available resources most effectively to meet the needs of all local people.

We are continuing to talk to staff, stakeholders, patients and local communities to hear their views on our work to date. Please continue to check our website for details of opportunities where you can come and find out more, share your views and give your feedback as we develop potential solutions to the challenges we have set out. No final decisions have been made on the future of services and won’t be until after proposals have been fully developed and until we have formally consulted on these early next year.

Over the summer, doctors and local health leaders have continued their work considering what services the population in Weston and surrounding areas needs in the future and how they can best be delivered. There are four key issues that need to be addressed:

Our population is growing, getting older, living with more long-term conditions, and there are significant inequalities in health amongst our local communities – people have changing health needs we need to meet.

There is variation in the way GP, primary and community care teams currently provide care across the area, with some patients finding it more difficult than others to access the right care for example

Some of our hospital-based services at Weston are not able to consistently meet national clinical quality standards because of low volumes of particular cases and specialist staffing shortages.

There is a growing financial gap between rising costs and available funding. We must live within our means, get best value and make sure we use our available financial resources most effectively to meet the needs of the whole population.

All of these mean we need to make some changes across the local health and care system.

New ways of working

The challenges and opportunities, and the ambition for local services, were set out in a ‘Commissioning Context’ document by Bristol North Somerset and South Gloucestershire Clinical Commissioning Group in October 2017.

This paved the way for many conversations with staff, patients and local people and identified three areas for change:

Changes we can put in place immediately and are getting on with; such as better support for people in care homes, improving home visiting by GPs, (and developing a consistent approach to frailty assessments in the community).

Changes we can implement imminently but require further work; for example, developing a business case to establish a mental health crisis café in the centre of Weston, and better integrating children’s services across different provider organisations.

Changes that would enable us to ensure we have a strong and focused hospital at Weston, able to deliver to the highest clinical quality standards and that is affordable for the long-term within our available funding; for example, developing better multi-agency working and identifying new clinical models and ways to deliver services sustainably.

In this latter area we have now started the work on looking at potential clinical models and will then have a further period of listening and co-design before going to
formal public consultation early next year.

We know we need to think about how we can design strong and focused services at Weston hospital, to make sure it can continue to deliver high quality services that best meet local people’s needs into the future. This includes identifying the services that Weston General Hospital is best placed to provide, and which services may be more effectively provided to local people by one of our neighbouring hospitals or in the community. Similarly, there may be services currently provided in other places which are better delivered and consolidated in Weston hospital. The issues we face here are common to many communities with smaller hospitals across the country and our ambition is that we make Weston Hospital an exemplar of how services can be designed and delivered sustainably by smaller hospitals in the future.

The work over the summer, led by a group of clinicians from Weston Hospital, Bristol, North Somerset and South Gloucestershire Clinical Commissioning Group, neighbouring hospitals and other partners has been focused on this element and has made good progress.

Alongside this there is work underway to make sure that the services people need in their local community – GP services, community, mental health, ambulance services, work with voluntary sector partners – are there when people need them and complement the services delivered in hospital.

Identifying ‘what good looks like’

The clinicians have looked at best practice in the way care can be delivered, internationally and nationally. From this they have identified the ideal journey a patient should take from the start to the end of their care and what treatment they should expect from a clinical perspective for different areas of care. These areas include: care for people with frailty and long-term conditions; maternity and services for unwell children; planned care services (for example, planned operations and treatments); and urgent and emergency care. They have discussed ‘what good looks like’ in terms of clinical quality, for example: how and when diagnostic tests and interventions should be started; who is best able to provide the right care; how and when to escalate to more specialist services and ease of step down from these; and how innovations in technology could support and enhance the delivery of services in new ways.

The clinicians have been discussing a wide range of possible models of care to deliver the best practice they have described, informed by practice that happens elsewhere. These models are based on the national clinical standards that exist and what it is theoretically possible to provide in areas such as A&E, maternity care, planned surgery and children’s services.

Bringing different areas of best practice together to design potential ‘models of care’

By looking at five different potential ways to deliver A&E, four different ways to deliver emergency surgery, five different ways to deliver emergency medicine, four different models of critical care, three different ways to deliver maternity services, five models for children’s services and four different ways to deliver planned care services, over 1,000 different permutations of how services could be designed have been identified.

Developing potential models for Weston

Clinicians have looked at the links between different services; how services work together and what different supporting services each needs. Thinking in this way and applying some high level evaluation criteria enabled the clinicians to rule out many of the permutations to arrive at a more realistic set of potential models of care for Weston.

Systematically and carefully over the summer the clinical group narrowed the number of potential options down to six clinically distinct and different ways of delivering urgent and emergency care along with a combination of frailty, maternity, children’s services, and planned operations for the people of Weston.

Common features amongst all the models of care

All the models of care include bringing together services for frail older people in a joined up way as this was one of the most important things we heard from our engagement with local people earlier this year. This will mean that in future, for example, an older person who may be confused, has had a fall, and is struggling to cope at home alone could be cared for by a team that links their GP, community based clinicians, and social care services together, as well as hospital staff, in a more comprehensive way. In this way people will be supported to stay healthy, well and independent in the community. And, where they do need hospital care, they will be supported to get back to independent living as soon as possible.

In addition, all the models include outpatient services, diagnostic imaging (x-ray, ultrasound, CT, MRI scans) and pathology services (for example for blood or urine testing) and joined up services for those with long-term conditions. They would all seek to maximise the opportunities to use technology to improve access to services and to enhance closer working between specialist teams.

All the models rely on good, comprehensive GP, community and mental health services across the local area, working more closely with hospital teams and the ambulance service, and with those who provide day-to-day home and social care support for local people.

Applying the models of care to Weston

The six clinically possible models have been singled out for further detailed analysis and work because they are distinctive and different enough to be explored, tested,
analysed and compared further as part of a rigorous process to identify the best potential way of delivering services. The clinicians deliberately agreed to identify models that were significantly different from one another and covered the full range of possible models for Weston. This has been done purposefully so we can be confident we have looked at all possibilities thoroughly and robustly. It is important to emphasise none of these models have been selected for Weston. The next stage of the design work is to look at the models and apply them specifically to the needs of people in Weston, looking at current services delivered across North Somerset, the workforce needs and costs of each and so on, and to determine and describe the best, most viable, workable options that meet local needs.

Next steps in the process

Those options identified with the best potential will undergo more detailed analysis until we are able to identify preferred option(s) for public consultation next year. Building on the outcomes of our earlier public listening exercise, criteria to evaluate and compare each option have been developed and agreed in discussion with clinicians, staff, patients and local people. They cover quality of care, access, deliverability, workforce and affordability. The clinical group, and ultimately the Governing Body at Bristol, North Somerset and South Gloucestershire CCG, will use these to assess the options and to support their decision-making.

An ongoing conversation

It has been clear for some time that we need to change the way we design and deliver services; to meet changing needs, to improve care outside of hospitals, to embrace new technologies and advances in medicine, to ensure we live within our financial means, and to secure a strong and dynamic future for Weston Hospital.

We have been talking with staff, stakeholders, patients and local communities for some time about how we can meet the challenges and embrace the opportunities.

We want to continue to hear views from the public, patients, staff, and stakeholders on the work to date and to ensure over the coming weeks that concerns, feedback, opportunities and benefits are captured to inform the work as it progresses.

No final decisions have been made on the future of services and won’t be until after a formal public consultation next year. In the meantime, we are continuing the conversation and there are a number of ways you can get involved and continue to give your views over the autumn and winter.

We will be holding public meetings and ‘drop-in’ sessions where you can come and find out more and give your feedback on our work so far, and will be providing information online and through leaflets and posters in GP surgeries, hospital waiting rooms and local community spaces.

On 10 October, local doctors and health leaders set out how we are progressing plans to improve health and care services in Weston-super-Mare and the surrounding area to better meet the changing needs of our communities at several listening events with members of the public, stakeholders, and staff at Weston General Hospital.

They talked about the way services, including those at Weston General Hospital, could be delivered in the future and asked for feedback on the work to date in order to help develop the best solutions.

These listening events are part of an on-going conversation with local people and there will be other opportunities to give your views over the coming weeks. Visit the Get Involved page to find out more.

Work is continuing to look at developing new ways of organising health and care services in Weston-super-Mare and the surrounding area. Services need to better meet people’s needs in the future and respond to the changing health and care needs of our communities.

We are building on the good work to date but recognise we need to be bolder, and more creative if we are to deliver sustainable health and care services in and outside of hospital in the future.

The widespread conversations late last year and earlier this year with patients, carers, members of the public, staff, and other key audience groups about the future of health and care services have been valuable and have helped us produce three programmes of work:

Improvements to services that can be implemented immediately or imminently. For example, a new unified approach to GPs providing services to local care homes; standardising telephony and shared back office IT systems for GPs to increase resilience; and training primary and community staff in more advanced and standardised frailty assessments .

Ideas and suggestions requiring further work and a supporting business case to ensure they are viable and have appropriate funding and support. For example, establishing a mental health crisis café, better integration of children’s services, and social prescribing (a means of enabling GPs, nurses and other primary care professionals to refer people to a range of local, non-clinical services for example, volunteering, gardening befriending, or a range of sports).

Delivering clinically and financially sustainable services that best meet the needs of the local population for the long term. This incudes identifying the services that Weston General Hospital is best placed to provide so it becomes a stronger, more focused hospital, and which services may be more effectively provided to local people by one of the other hospitals.

Over the summer, clinicans and health and care professioals are meeting to learn from how other parts of the country and the world deliver services in different ways to meet common challenges. For example, an ageing population living with more long-term conditions; smaller hospitals needing to remain sustainable; and the challenges of rural and coastal locations.

The clinicians will identify the opportunities for improving clinical outcomes, patient experience and more joined-up working between services and organisations across the whole of the Weston area.

They are looking at different areas of care, taking as headline themes those needing:

They are looking at a number of things such as the ideal journey a patient should take from the start to the end of their care and treatment from a clinical perspective; discussing ‘what good looks like’ in terms of clinical quality e.g. how and when diagnostic tests and interventions should be started; and how innovations in technology could support and enhance the delivery of services in new ways.

This will enable clinicans to develop a bespoke ‘model of care’ for our area to deliver improved health and care services in a sustainable way. Their emerging thinking will be tested with the public, patients, staff, carers and other audience groups in the autumn.

A series of potential options for the way services could be delivered in the future will be developed. From this, a short-list of options will become part of a ‘pre-consultation business case’ (describing the detailed workforce, activity, workforce, capital requirements etc to deliver them) for formal public consultation in 2019.

No decisions have yet been made on the future of services, and won’t be until after a full public consultation next year. We will continue to provide updates on our work over the coming months and if you would like to be involved in the next phase of design and discussion in the early autumn, please email bnssg.healthyweston@nhs.net.